Org Ana: The Thoracic Wall Flashcards
what comprises the exterior of the thoracic wall
covered by skin and muscles of the shoulder girdle
where is the thorax located
at the region between the head, neck and abdomen
what comprises the inner surface of the thoracic wall
lined by parietal pleura
what is the thoracic cage
bony framework or the thoracic region’s wall
describe the shape of the thorax
flat in front and at the back but rounded on the sides bc of the angulation of the ribs
what are the boundaries of the thoracic cage
anterior - sternum and costal cartilages
posterior - T1-T12
laterally - ribs and intercostal spaces
superiorly - w neck
inferiorly - diapraghm
what is the superior thoracic aperture
bordered by T1, rib 1 and manubrium
structures from the head and neck passes as it goes down
what is the inferior thoracic aperture
bordered by T12, rib 12 and rib 11, costal margin and xiphoid process
structures from thoracic to abdomen pass here
what are the functions of the thoracic wall
protects heart and lungs
conduit for passing structures from head to abdomen
role in breathing
supports UE
attachment of muscles
what are the lines of orientation in anterior view from lateral to medial
anterior axillary
midclavicular
midsternal
what are the lines of orientation in lateral view from posterior to anterior
posterior axillary
midaxillary
anterior axillary
what are the lines of orientation in posterior view from lateral to medial
scapular
vertebral
what are the spaces in anterior view from superior to inferior
supraclavicular
infraclavicular
precardiac
traubes
what are the spaces in posterior view from superior to inferior
suprascapular - T2
interscapular - T3
infrascapular - T7
describe the pleuras of the thoracic cavity from most superficial to deep
parietal - inner surface of chest wall
pleural cavity - space bet
visceral - lines the lungs
what are the 3 parts of the sternum
manubrium
body
xiphoid
what is the articulations of the manubrium
w/ clavicle - clavicular notch
w/ first nd upper parts of second costal cartilages - 1st costal notch
w/ body - manubriosternal joint
what level is the jugular notch
T2
what is the level of manubrium
T3-4
at what level is the manubriosternal joint located
sternal angle of louie - T4-5
where does the body of sternum articulate
2nd-7th costal cartilages - ribs 8-10 w/ rib 7
w/ manubrium - manibriosternal
w/ xiphoid - xiphisternal
describe the xiphoid
hyaline cartilage that ossifies at proximal end in adults
what are the articulations of the xiphoid process
no ribs or costal cartilage
7th costal cartilage may have along w/ body
w/ body - xiphisternal
inferior end - attachment for line alba
at what level can the xiphisternal joint be found
opposite T9
what is the significance of the sternal angle of louis
ribs are counted here - 2nd rib @ sternal angle
separates sup nd inf mediastinum
asc aorta ends, where arch is, desc aorta begins
trachea divides into bronchi
azygous vein arches over right lung into SVC
pulmonary trunk divides into pulmonary arteries
thoracic duct reaches left side here
upper limit of base of heart
cardiac plexus
what are the types of ribs
TRUE - first 7
- connected to sternum
FALSE - 8-10
- attaches to rib 7 by costal cartilages
- forms costal margin
FLOATING - 11-12
- no attachment to sternum
- costal cartilage embed to muscles at abdomen
what are the articulations of the head of a typical rib
sup - inferior costal facet of vertebra above
inf - articulates w the superior costal facet of its vertebrae
describe the typical rib
long, twisted and flat
sup border - round and smooth
inf border - sharp nd thin w costal groove
ant attaches to costal cartilage
describe the neck
separates head from tubercle
describe the head
posterior vertebral end
compare articular nd non articular parts of the tubercle
articular - articulates w numerically corresponding vertebra
non articular - attachment of ligament
describe the shaft
long, thin, flat and twisted on long axis from tubercle to sternal end
describe the costal groove
elongated depression found in the inferior internal surface of the shaft of rib; holds intercostal vessels and nerve.
describe the angle
where body sharply turns from a lateral to a more anteriorly directed orientation; slightly distal to the tubercle
describe the sternal end
flat and has a depression for the costal cartilage
describe the first rib
small, flattened from above downward; thick
attached only to T1 body; has a facet in the tubercle to articulate to the transverse process; 1 attachment only
scalene tubercle (superior surface) which separates two smooth grooves crossing the rib at the shaft
describe the subclavian groove of the first rib
Anterior groove (subclavian vein)
Posterior groove where lower trunk of brachial plexus (between clavicle and rib 1) and subclavian artery cross the rib and lie in contact with the bone
describe the second rib
Flat but twice as long as first rib; thicker than usual
Articulates with the vertebral column in a way typical of most ribs
describe the tenth rib
Head of rib 10 has a single facet for articulation with own vertebra; no other articulation to T9
describe ribs 11 nd 12
articulates only with the bodies of their own vertebrae;
have no tubercles or necks;
both are short, little curve and are pointed anteriorly;
has sternal end w costal cartilage embed to abdomen
what are costal cartilages
Hyaline cartilage connecting the upper seven ribs to the lateral edge of sternum and the 8th to 10th ribs to the cartilage immediately above
what is the function of costal cartilages
helps elasticity of thoracic wall - ribs expand
n old age, it tends to lose some of its flexibility as the result of superficial calcification
attaches rib to sternum
what are costal facets
demifacets - articular surface on the posterolateral aspect of the body at the junction of body and pedicle; located in superior and inferior sides;
compare sup nd inf demifacets
Superior articular facet faces posterolateral and inferior articular facet faces anteromedial
describe T1
a full costal facet for the head of 1 strib and inferior demifacet for the superior half of the head of the second rib
describe T11-12
costal facets (located mainly on the pedicles) instead of demifacets because the heads of ribs 11 & 12 articulate only with their own individual vertebrae
what are transverse costal facets
for articulation of the tubercle of the rib on the transverse processes; absent in T11 and T12
describe the movement of the sternal joint
small amount of angular movement during respiration
what is the landmarks for the sternal joint
opposite T4
attachment of 2nd costal cartilage
plane of separation bet sup nd inf mediastinum
what type of joint is the sternal joint
cartilaginous
what type of joint is the costovertebral
synovial plane
which ribs have single synovial joints
1, 10, 11, 12
which ribs have 2 synovial joints
2-9
what connects the head of a rib to the IV disc
intra-articular lig
what type of joint is the tubercle to transverse process
synovial pane
absent in 11-12 bc no tubercle
what type of joint is the rib to costal cartilage
cartilaginous - no movement
describe the joints betw costal cartilage and sternum
1st rib to manubrium - cartilaginous = no movement
2nd to 7th - synovial plane - lateral border of sternum
6th - 10th - synovial plane - cc articulates w one another
what type of joint is the manubriosternal
cartilaginous
what type of joint is the xiphisternal
cartilaginous
explain the significance of the 1st rib and the 12th rib during respiration
1st rib raises ribs during inspiration
12th rib pulls ribs down during expiration
what are the structures that pass through the thoracic outlet
esophagus
trachea
vessels and nerves
apices of the lungs and pleura
what is the thoracic outlet syndrome
compression of brachial plexus or the subclavian vein/artery as it exits rib 1 and clavicle
what are the vascular symptoms of thoracic outlet syndrome
swelling/puffy hands
cyanotic hands
heaviness of arm
pulsating lump above clavicle - weak radial pulse
tooth ache like pain at neck and shoulder - inc at night
easily fatigued arms
superficial vein distention in hand
what are the neurologic symptoms of thoracic outlet syndrome
paresthesia at C8 and T1 dermatomes - inside forearm and palm
C8: closing and opening of palms
T1: add nd abd of fingers
muscle weakness nd atrophy in gripping
difficulty in fine motor tasks
cramps of inner forearm
pain
tingling and numbness
what is the cause of thoracic outlet syndrome
cervical rib - extra rib at C7 = higher chance of pinch
scalene syndrome - pinch bet movement of ant and middle scalene
costoclavicular syndrome - bet clavicle and rib 1
hyperabduction syndrome -hyper abd of shoulder like backpack may pinch in betw rib 1 and clavicle
how to test for thoracic outlet syndrome
allen - elbow at panatang makabayan nd head pointed away - radial pulse dissapears as head rotates = +
adsons - UE in abd, extension and ER - head towars involved side - diminished radial pulse = +
costoclavicular maneuver - exaggerated attention posture - absence of pulse = +
done if complains of pain during back pack etc
what is an intercostal space
space bet ribs
where costal groove lies - intercostal nerves, arteries and vein
what are the layers of the thoracic wall from superficial to deep
skin
superficial fascia
deep fascia
intercostal membrane
endothoracic fascia
extrapleural fatty layer
parietal pleura
compare the intercostal muscles
external - most superficial
down nd forward
internal - intermediate
down nd back
innermost - deepest
straight arrangement
relates to endothoracic fascia nd parietal pleura
what fixes the first rib
scaleni muscle
what fixes the 12th rib
quadratus lumborum and oblique muscles
relate intercostals to respiration
external - elevates
internal - depresses
strength prevents sucking in or blowing out of lungs during changes in psi
what are the 3 parts of the diaphragm
sternal - from posterior surface of xiphoid
costal part - from deep surface of lower six ribs nd cc
vertebral - from the VC (crura) and arcuate ligaments
compare left nd right crus
left - from L1-2
right - L1-3
compare the medial and lateral arcuate ligaments
medial - side of L2 body to transverse process of L1
lateral - transverse process of L1 to lower border of 12th rib
what is the central tendon
muscle fibers of diaphragm that converge in the center at T9
sup surface partially fused w pericardium
acts as a sphincter to prevent regurgitation of stomach contents
compare left nd right diaphragm
r - reaches upper border of rib 5
l - reaches lower border of rib 5
right is higher bc liver pushes it up
relate the levels of the diaphragm in diff positions
sitting/standing - lower
supine/after meal - higher
what are the openings of the diaphragm
caval - T8 in the central tendon
inf vena cava and right phrenic nerve
esaphogeal - T10 in muscles from right crus
esophagus
vagus nerve
left gastric vessel
lymphatics
aortic - T12 bet crura - gap behind posterior margin
aorta
thoracic duct
azygos vein
thoracic aorta becomes abdominal aorta
what passes at the crura
greater, lesser and lowest sympathetic splanchnic nerves
what passes medial arcuate ligament
sympathetic trunk passes posterior
what passes betw sternal and costal margin
superior epigastric vessel
what passes at the left dome
left phrenic nerve
arterial supp of diaphragm
pericardiophrenic and musculophreninc arteries - from internal thoracic art
superior phrenic (thoracic) and inferior phrenic (abdominal)
venous supp of diapraghm
drains to brachiocephalic, azygos/abdominal veins
where does intercostal nerves come from
anterior rami of spinal nerves T1-11
T12 is subcostal nerve
describe the passage of intercostal nerves
first six - distributed w/in their intercostal spaces
seventh to ninth - leave anterior ends of their intercostal spaces by passing deep to cc to enter the abdominal wall
10-11 = pass directly to abdominal wall
what does intercostal nerves carry
somatic motor intervention to muscles of thoracic wall
sensor innervation skin and parietal pleura
postganglionic sympathetic fibers to periphery, autonomic
anterior ramus of T1 forms part of brachial plexus
lat cutaneous branch of 2nd intercostal - sensory of upper arm
lower intercostal supplies muscle, skin nd peritoneoum of abdominal wall
whats the arterial supp of thoracic wall
subclavian - sup intercostal nd internal thoracic
axillary - sup nd lateral thoracic
thoracic aorta - posterior intercostal and subcostal
ant intercostal from lat thoracic - branch to 12 arteries to the ribs
what is the venous drainage of thoracic wall
right - superior intercostal azygos
left - superior thoracic brachiocephalic veins
